Systemic lupus erythematosus
From Wiki4CAM
Systemic lupus erythematosus (SLE) is a chronic, inflammatory autoimmune disorder. It may affect the skin, joints, kidneys, and other organs. [1]
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Signs and symptoms
Initially SLE may affect one organ or the body system but others may become get involved later. About 90% of all patients are with arthritic symptoms. Frequently affected joints are the fingers, hands, wrists, and knees. Cardiopulmonary features include pericarditis, endocarditis, myocarditis pleurisy fibrosing alveolitis and acute lupus pneumonitis, resulting symptoms of chest pain, arrhythmias and dyspnoea. Skin rashes are seen in more than two-thirds of patients. A "butterfly" (malar) rash over the cheeks and bridge of the nose is the classical presentation and affects about half of those with SLE. There may also be discoid lupus, which is one of the diagnostic criteria. Alopecia is seen in more than 50% of patients. SLE may also result in nephrotic syndrome and renal failure. Central nervous system involvement occurs in 50% of the patients which usually results in mild psychiatric disturbance, epilepsy, severe depression, dementia, cranial nerve lesions or peripheral neuropathy. General symptoms associated with the condition include fever, fatigue, general discomfort, sensitivity to sunlight and joint swelling, swollen glands, muscle aches, nausea and vomiting, blood in the urine coughing up blood, nosebleed, difficult swallowing, numbness and tingling, mouth sores, hair loss, abdominal pain and visual disturbance.
Classification criteria for the diagnosis of SLE
As per the internationally accepted following classification criteria, any combination of 4 or more of 11 criteria, makes it likely that the patient has SLE.
- Malar rash
- Discoid rash
- Photosensitivity
- Oral ulcers
- Arthritis
- Serositis
- Renal disorder 1. (a)>0.5 g/d Proteinuria or (b) ≥3+ dipstick proteinuria or 2. Cellular casts
- Neurologic disorder 1. Seizures or psychosis
- Hematologic disorder 1. Haemolytic anemia or 2. Leucopoenia [low level of WBC (<4000/mcL)] or lymphopenia [low level of lymphocytes (<1500/mcL)] or 3. Thrombocytopenia (<100,000/mcL)
- Immunologic disorder 1. Positive to LE cell preparation or antibody to native DNA or antibody to Sm (Sm or Smith antigen is an antigenic protein found in 30% of SLE patients) 2. False positive serological test for syphilis
- Positive Antinuclear antibodies
Examination and investigation
Apart from the above criteria following investigations are usually helpful to find out the condition and severity. Chest x-ray showing pleuritis or pericarditis; urinalysis to show blood, casts, or protein in the urine; kidney biopsy if needed.
Management
Treatment is aimed at giving the better quality of life. Condition should be managed and treated according to the Individual’s symptoms. Plan of treatment should be made as per the individual’s affected system and organ. Protective clothing, sunglasses, and sunscreen when in the Sun are recommended to manage skin symptoms.
Prognosis and complications needing specialised medical care
Prognosis is good in well-managed cases. In people with severe involvement of the brain, lungs, heart and kidney, the prognosis is comparatively lower than others. Complications usually include lupus nephritis, Infection, thrombocytopenia, hemolytic anemia, myocarditis and seizures. The presence of anti-phospholipid antibodies may increase the possibility of pregnancy loss.
CAM therapies for systemic lupus erythematosus
Ayurveda
Homeopathy
Role of homoeopathy in SLE depends on the progression of the disease. If it is diagnosed early, the homoeopathic approach is to limit the progression of disease. In progressed disease, the approach is towards alleviation of symptoms and better quality of life. Often used homoeopathic remedies are tabulated below.
Agaricus muscarius Seizures and twitching groups of muscle; trembling and tonic contractions of smooth muscle fibre; neuralgic pains and stiffness all over the limbs.
Causticum Rheumatic, tearing pains in the limbs; inability to lie still a moment; flexor muscles seem to be shortened; sensitiveness to cold and draft of air; complaints worse in the evening and open air; cough with raw and soreness in the chest in cases with cardiopulmonary features.
Kalium bichromicum Tearing pains suddenly shift from one place to another, better by motion; pains along the bones or tendons worse in the morning on waking; better on rising; pain in sternum along with cough and expectoration of profuse, yellow and stringy sputum.
Kresotum Pain in the joints as if sprained with stiffness; boring pain in the hip, alternating with numbness
Lycopodium Jerking of the arms and shoulders; drawing and tearing pains worse during rest and night; stiffness of all the joints; dry skin of the hands; finger joints red and swollen; contractive pain in the calves when walking; swelling of the feet, which are habitually cold.
Natrum muriaticum Limbs feel weak and bruised in the morning; burning blisters in the mouth and on the tongue; weakness of arms and legs; feeling of tightness in the calves; itching eruption like nettle-rash on the margin of the hair at the nape of the neck.
Nitricum acidum Sharp pains suddenly appearing and disappearing; pains are felt even during sleep; hair loss with sensitive scalp.
Phytolacca Convulsions with sore bruised feeling with stiffness; prostration; arthritis particularly below the elbows and knees; tearing associated with stiffness and lameness of the muscles; pains fly about.
Silicea Trembling, shooting pains and paralytic sensation in the limbs; nervous weakness and restlessness after sitting a long time; desire to lie all the time; feet become sore, with sharp pains.
Thuja Muscular twitching and trembling with weakness; pain, swelling and redness of the tip of the fingers; pain and violent itching with fissured eruption; profuse perspiration from the feet.
Vanadium metallicum Anaemia; increases amount of haemoglobin, increases and stimulates phagocytes.
